Evaluation of Emphysema in Patients with Asthma Using High-resolution CT

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversibility of airway obstruction. However, many asthmatics have evidence of residual airway obstruction. It has become evident that the repair of the chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for the change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characteristics in asthmatics with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups : Asthmatics with emphysema and the ones without emphysema. REWSULTS: Of the 58 patients, 7 were revealed to have emphysema. (1) 6 asthmatics with emphysema were smokers, but one patient was a nonsmoker. (2) Highly significant differences between asthmatics with and without emphysema were found in cigarette smoking (p< 0.01) and smoking consumption (p< 0.01). (3) There were no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There were no significant differences in FEV1(%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%) and DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickeness (p< 0.05) and in total Ig E levels (p=0.07). CONCLUSION: These results indicate that smoking is a main factor in causing emphysema in asthmatics.

Clinical Features of Eosinophilic Bronchitis

BACKGROUND: Eosinophilic inflammation of the airway is usually associated with airway hyper-responsiveness in bronchial asthma. However, there is a small group of patients which has the eosinophilic inflammation in the bronchial tree with normal spirometry and no evidence of airway hyper-responsiveness, which was named eosinophilic bronchitis. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features and course of eosinophilic bronchitis. METHODS: We evaluated 92 patients who had persistent cough for 3 weeks or longer. In addition to routine diagnostic protocol, we performed differential cell count of sputum. Eosinophilic bronchitis was diagnosed when the patient had normal spirometric values, normal peak expiratory flow variability, no airway hyper-responsiveness and sputum eosinophilia (>3%). RESULTS: The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, chronic bronchitis in 15% and eosinophilic bronchitis in 12% of the study subjects. Initial eosinophil percentage in the sputum of patients with eosinophilic bronchitis was 26.8+/-6.1% (3.8-63.7%). Treatment with inhaled steroid is related with a subjective improvement of cough severity and a significant decrease of sputum eosinophil percentage (from 29.1+/-8.3% to 7.4+/-3.3%). During the follow-up period, increase in sputum eosinophil percentage with aggravation of symptoms were found. CONCLUSION: Eosinophilic bronchitis is one of the important cause of chronics cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Cough in eosinophilic bronchitis is effectively controlled by inhaled corticosteroid, but may follow a chronic course.

Clinical features of eosinophilic bronchitis / 대한내과학회지

BACKGROUND: Sputum examination is known to be a valid and reliable method in assessing airway inflammation. Eosinophilic inflammation of airway is usually associated with airway hyperresponsiveness and reversibility. But eosinophilic bronchitis present with chronic cough without the abnormality of airway function. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features of eosinophilic bronchitis. METHODS: We evaluated 92 patients who had been coughing for more than 3 weeks. In addition to usual diagnostic protocol, we performed sputum analysis for differential cell count. Eosinophilic bronchitis was diagnosed if patients had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness, and sputum eosinophilia (>3%). RESULTS: The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, bronchitis in 15%, and eosinphilic bronchitis in 12%. Initial eosinophil percentage in sputum of patients with eosinophilic bronchitis was 26.8+/-6.1% (3.8-63.7%). Treated with inhaled steroid, subjective improvement in cough and significant decrease in sputum eosinophil percentage (from 29.1 +/-8.3% to 7.4+/-3.3%) were observed. During the follow up period, increases in sputum eosinophil percentage with aggravation of symptom were found. CONCLUSION: Eosinophilic bronchitis is an important cause of chronic cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Symptoms in eosinophilic bronchitis are effectively controlled by inhaled corticosteroid, but they may follow chronic course.

Evaluation of emphysema in asthma patients using high-resolution CT / 대한내과학회지

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.

Evaluation of emphysema in asthma patients using high-resolution CT / 대한내과학회지

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.

Perception of Wheezing in the Elderly Asthmatics

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.

Relationship between bronchiectasis with wheeze and asthma / 대한내과학회지

BACKGROUND: Wheezes are the oscillation of airway walls that occures when there is airflow limitation, as may be produced by bronchospasm, airway edema or collapse or intraluminal obstruction by neplasm or secretions. Wheezes can be observed in about 34% of bronchiectasis, that defined as abnormal and permanent dilatation of bronchi. Bronchiectasis is associated with bronchial asthma in 2.7-42%. We studed the clinical significance of wheeze observed in bronchiectasis and interrelationships between the bronchiectasis with wheeze and bronchial asthma. METHODS: We reviewed the 32 patients with bronchiectasis confirmed by HRCT. Exclusion criteria are acute exacerbation of bronchiectasis, neoplasm, bronchial asthma. The controlled group is 29 bronchial asthma patients and their diagnositc criteria is when the %change of FEV1 after inhaled bronchodilators is 12% or more and absolute change value is >or =200 mL. All patients were performed spirometry, bronchodilator test, bronchial hyperresponsiveness to methacholine, skin prick test and sputum analysis for cell counts. RESULTS: The Wheeze observed in 43.7% of bronchiectasis patients. Wheeze group revealed the more obstructive pattern in spirometry than non-wheeze group (FEV1% 71.0+/-8.2% vs 91.7+/-5.5%, p=0.04; FEV1/FVC 61.1+/-4.4% vs 78.2+/-3.7%, p=0.009), more bronchodilator responses (8.4+/-2.1% vs 4.9+/-1.7%, p=0.045) and more bonchial hyperresponsiveness (positive results in PC20 : 2 in 6 patients vs no positive in 3 patients). Asthma control group has no significant differences with wheeze group. But compared with non-wheeze group, it has significantly decreased lung function (FEV1/FVC 65.5+/-2.9% vs 78.2+/-3.7, p=0.004), more bronchodilator responses (14.8+/-0.6% vs 4.9+/-1.7%, p=0.001) and more eosinophilic airway inflammations (sputum eosinphile% 11.4+/-2.0 vs 0.8+/-0.4, p=0.05). CONCLUSIONS: The wheezes observed in bronchiectasis are associated with bronchial hyperres ponsiveness and eosinophilic airway inflammations.

Prevalence of asthmatic symptoms and clinical characteristics in elderly asthmatic patients / 천식및알레르기

No abstract available.

Perception of wheezing in the elderly asthmatics / 대한내과학회지

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.

Effect of theophylline on Bc 1 - 2 expression of Il - 5 stimulated eosinophil / 천식및알레르기

BACKGROUND AND OBJECTIVE: Eosinophil is a major inflammatory cell in allergic diseases and parasitic infestations. Various cytokines such as GM-CSF, IL-3 and IL-5 are known to activate eosinophils and prolong their survival. Among them, IL-5 is the most potent stimulator of eosinophil survival. Recently, it was reported that increased expression of Bcl-2 is related to prolonged survival of IL-5 stimulated eosinophil. Theophylline is a useful drug in bronchial asthma, due not only to bronchial dilation but also to its anti-inflammatory effects. It has been suggested that anti inflammatory action of theophylline derives from the reduction of inflammatory cells in the airways which is mechated by stimulat on of apoptosis of inflammatory cells. In this study, we investigated, by measuring Bcl-2 expression of IL-5 stimulated eosinophil, the effect of theophylline on apoptosis as one of the anti-inflammatory action. MATERIAL AND METHOD: Peripheral eosinophils were isolated from atopic patients by using Perco- 11 discontinuous gradient and purified by negative selection technique using MACS. Eosinophil viability and apoptosis were measured by FACscan. Expression of Bcl-2 protein in eosinophils was detected by Western blot and ELISA. RESULTS: IL-5 increased the percentage of viable eosinophils and reduced the apoptosis of eosinophils in a dose dependent manner. The increased survival of IL-5 stimulated eosinophils was reduced by theophylline via activation of apoptosis. Bcl-2 was increased when eosinophils were cultured with IL-5 only, but when theophylline was cocultured, reduced Bcl-2 was seen with Western blot and ELISA. CONCLUSION: IL-5 increases the survival of eosinophil through the enhanced expression of Bcl- 2. Theophylline has counter action against IL-5 via inhibition of Bcl-2 induced by IL-5. Inhibiting the prolongation of eosinophil survival caused by IL-5 might be one possible mechanism of antiinflammatory effects of theophylline.

Risk factors of near-fatal asthma / 대한내과학회지

No abstract available.

Intracellular signal transduction of interleukin-6 production bylipopolysaccharide-stimulated fibroblasts / 대한내과학회지

OBJECTIVES: Stimulation of cell results in a variety of early biochemical events, known as signal transduction pathway and ultimately leads to final outcome like cell proliferation or cytokine production. The intracellular signal transduction pathway of IL-6 production by LPS stimulated fibroblast is not well defined. In present study, we investigated what signal transduction pathway is involved in IL-6 production. METHODS: We examined the effects of various inhi bitors of signal transduction pathway including pertussis toxin, cholera toxin, genistein, indomethacin, EDTA, nife dpine, sphingosine, staurosporine, and H8 on the produc tion of IL-6 by human fetal fibroblast MRC-5 after stimulation with LPS. IL-6 was measured by bioassay in supernatant of LPS stimulated fibroblast MRC-5 after pretreatment with inhibitors. RESULTS: Calcium inhibitor (EDTA) and protein kinase inhibitor (staurosporine) reduced IL-6 production by LPS stimulated fibroblast. Protein tyrosine kinase inhibitor(Genistein) and PKC inhibitor(sphingosine) had no influence on IL-6 production. Cholera toxin and pro staglandin inhibitor (indomethacin) led to increase in IL-6 production by LPS stimulated fibroblasts. CONCLUSION:: These results suggest that G protein associated receptors, through the calcium dependent pathway, are working in IL-6 production by LPS stim ulated fibroblasts.

Colonoscopic Diagnosis of Whipworm Infection / 대한소화기내시경학회지

Trichuriasis is an intestinal infection of human beings caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult trichuris. It is prevalent throughout the world, especially in tropical areas. Diagnosis is made typically by the identification of characteristic barrel-shaped eggs in the feces, although adult worms may be seen rarely at sigmoidoscopy or colonoscopy. We report five cases of whipworm infection that was diagnosed on colonoscopic examination.